Actuation of a device comprising mechanical arms

ABSTRACT

Some embodiments of the invention relate to a mechanism for actuating a shaft having two degrees of freedom, comprising: a first actuator configured to rotate the shaft around the shaft axis, and a second actuator configured to bend the shaft using one or more elongated elements attached to the shaft, wherein actuation of the first actuator indirectly manipulates the elongated elements controlled by the second actuator, thereby affecting operation of the second actuator. Some embodiments relate to motorized actuation of a system comprising at least one surgical arm.

RELATED APPLICATION

This application is related to PCT Patent Application No.PCT/IL2015/050893 filed on Sep. 4, 2015, the contents of which areincorporated by reference as if fully set forth herein in theirentirety. This application is related to PCT Patent Application No.PCT/IL2016/050976 filed on Sep. 4, 2016, the contents of which areincorporated by reference as if fully set forth herein in theirentirety.

FIELD AND BACKGROUND OF THE INVENTION

The present invention, in some embodiments thereof, relates to actuationof a device including at least one surgical arm and, more particularly,but not exclusively, to a motor unit configured for actuating at leastone surgical arm.

Background art includes: “Design of a Compact Robotic Manipulator forSingle-Port Laparoscopy” by Claudio Quaglia et al, Paper No: MD-13-1148in J. Mech. Des. 136(9), 095001 (Jun. 13, 2014); “An inverse kinematicsmethod for 3D figures with motion data” by Taku Komura et al.,Proceedings of the Computer Graphics International (CGI'03);

Hubens et al., 2004, “What Have we Learnt after Two Years Working withthe Da Vinci Robot System in Digestive Surgery?”, Acta chir belg;

Michael Irvine, 2009, “Anaesthesia for Robot-Assisted LaparoscopicSurgery”, Cont Edu Anaesth Crit Care and Pain;

Jeong Rim Lee, 2014, “Anesthetic considerations for robotic surgery”,Korean Journal of Anesthesiology;

Teljeur et al., 2014, “Economic evaluation of robot-assistedhysterectomy: a cost-minimisation analysis”, BJOG;

Box et al., 2008, “Rapid communication: robot-assisted NOTESnephrectomy: initial report”, J Endourol; DR. Domigo, 2009, “Overview ofcurrent hysterectomy trends”, Expert Review of Obstetrics & Gynecology;and DR. Kho, “Vaginal versus laparoscopic hysterectomy”, ContemporaryOB/GYN Expert Advice, 2013.

Additional background art includes U.S. Pat. Nos. 8,224,485, 8,347,754,7,833,156, 8,518,024, International Patent Application Publication No.WO 2010096580, and International Patent Application Publication No. WO2013116869.

SUMMARY OF THE INVENTION

According to an aspect of some embodiments of the invention, there isprovided a mechanism for actuating movement of a shaft having twodegrees of freedom, comprising: a first actuator configured to rotatethe shaft around the shaft axis; a second actuator configured to bendthe shaft using one or more elongated elements attached to the shaft;wherein actuation of the first actuator indirectly manipulates theelongated elements controlled by the second actuator, thereby affectingoperation of the second actuator.

In some embodiments, the mechanism comprises at least one motor and atleast one of the first and second actuators comprises at least one geardriven by the motor.

In some embodiments, the indirect manipulation comprises changing aposition of the elongated elements in response to rotation of the shaftby the first actuator.

In some embodiments, rotation of the shaft by the first actuatortensions at least one of the elongated elements controlled by the secondactuator.

In some embodiments, the elongated elements are attached to the shaft ata point distal to a flexible joint of the shaft.

In some embodiments, the second actuator is configured to respectivelytension and releases the elongated elements to cause flexion andextension of the joint.

In some embodiments, one or both of the first and second actuatorscomprises a gear.

In some embodiments, the gear is positioned to rotate about the shaftaxis.

In some embodiments, both of the actuators comprise gears and arepositioned to rotate about the shaft axis.

In some embodiments, relative actuation of the first and secondactuators is configured to bend the shaft.

In some embodiments, the relative actuation comprises driving theactuators at different speeds.

In some embodiments, unified actuation of the first and second actuatorsis configured to rotate the shaft as a single rigid body.

In some embodiments, each of the actuators is driven by a motor.

In some embodiments, a gear of the motor or one or more transmissiongears driven by the motor are positioned to interfere, at least in part,with rotation of the second actuator.

In some embodiments, an amount of friction imposed on the secondactuator by the interference effects a final shaft articulation actuatedby the mechanism.

In some embodiments, when high friction is imposed on the secondactuator, actuation of the first actuator results in simultaneousrotation and bending of the shaft; and when low or no friction isimposed on the second actuator, actuation of the first actuator resultsin rotation of the shaft as a rigid body.

In some embodiments, the shaft forms at least a portion of a surgicalarm.

According to an aspect of some embodiments of the invention, there isprovided a surgical system comprising a surgical arm comprising at leastone joint; a motor unit configured to actuate articulation of the atleast one joint of the surgical arm, the motor unit comprising aproximal extension of the arm; wherein the motor unit comprises at leastone actuation mechanism configured for one or both of rotating at leasta portion of the arm around its axis and bending the at least one joint,the actuation mechanism operably coupled to the extension of the arm.

In some embodiments, the portion of the arm which is moved by theactuation mechanism is configured proximally to the joint.

In some embodiments, the arm comprises at least one inner shaft nestedwithin an outer shaft, the inner and outer shafts extending in aproximal direction and forming the proximal extension of the arm.

In some embodiments, the actuation mechanism comprises a first proximalgear and a second distal gear; wherein the outer shaft is operablycoupled to the distal gear, and the inner nested shaft extends in aproximal direction to and through the proximal gear.

In some embodiments, each of the gears is driven directly or via a geartransmission by a motor.

In some embodiments, the arm comprises 3 joints actuated by 3 actuationmechanisms.

In some embodiments, more than one actuation mechanism is actuated togenerate a selected articulation of the arm.

In some embodiments, articulation of the outer shaft is performedconcurrently with articulation of the inner shaft.

In some embodiments, the actuation mechanisms are collinear.

In some embodiments, the system comprises two surgical arms and themotor unit comprises actuations mechanisms for articulating both arms.

In some embodiments, the motor unit is less than 500 mm in length andless than 70 mm in width.

In some embodiments, the motor unit comprises one or more positionsensors for indicating a current angular position of the motor gear.

In some embodiments, a controller of a first motor is configured toreceive input from a position sensor of a second motor and to controloperation of the first motor in response to the input.

According to an aspect of some embodiments of the invention, there isprovided a mechanism for linear movement of elongated elements driven byrotational movement, comprising: a gear operably coupled to a threadedscrew, the gear configured to rotate the screw around the screw axis; atleast two rider elements coupled to the thread of the screw; wherein afirst rider element is attached to at least one first elongated elementand a second rider element is attached to at least one second elongatedelement; wherein rotation of the screw moves the rider elementslaterally in opposing directions, tensioning the first elongated elementand releasing tension of the second elongated element or vice versa.

In some embodiments, rotational movement of the rider elements aroundthe screw is limited by one or more protrusions configured on aninternal face of a housing in which the screw is received.

In some embodiments, a coupling between the gear and the screw comprisesa clutch. In some embodiments, the clutch comprises a spring coupled tothe screw such that when torque and/or tension produced by rotation ofthe screw exceeds a threshold, the spring yields and further rotation ofthe screw is no longer effective to actuate movement of the elongatedelements.

In some embodiments, the clutch comprises one or more springs attachedbetween the rider elements and the elongated elements such that when anelongated element is tensioned above a threshold, the spring yields andfurther movement of the rider element is no longer effective to tensionthe elongate element.

In some embodiments, each of the rider elements is attached to twoelongated elements.

In some embodiments, the elongated elements are each coupled at theirproximal end to the respective rider element, and at their distal end toa shaft which forms at least a portion of a surgical arm.

In some embodiments, the elongated elements are coupled to the shaft ata point distal to a flexible joint of the shaft.

According to an aspect of some embodiments of the invention, there isprovided a mechanism for actuating a shaft having two degrees offreedom, comprising: a tubular shaft; first and second actuatorsdisposed at an end of the tubular shaft, the actuators collinear to thetubular shaft; wherein the first actuator is configured to actuate shaftmovement of a first type, and the second actuator is configured toactuate shaft movement of a second type, the movement of a second typedifferent than the movement of a first type.

In some embodiments, one or both of the first and second actuatorscomprises a gear.

In some embodiments, the first and second actuators are configured tomove about a central axis of the tubular shaft.

In some embodiments, the first and second actuators are spaced apartfrom each other.

In some embodiments, the first actuator is directly coupled to thetubular shaft and the second actuator is indirectly coupled to thetubular shaft.

In some embodiments, the second actuator is coupled to the tubular shaftvia one or more elongated elements extending between the second actuatorand the tubular shaft.

In some embodiments, movement of a first type comprises rotation of thetubular shaft around its axis and movement of a second type comprisesbending of the tubular shaft.

According to an aspect of some embodiments of the invention, there isprovided a method of maintaining calibration of a surgical arm,comprising positioning an extension of a surgical arm in a motor unitconfigured to actuate articulation of the surgical arm by comprising oneor more gears operably coupled to the extension; during positioning,interfering with movement of the one or more gears to maintain acalibrated state of the surgical arm.

In some embodiments, interfering comprises changing a position ofinterfering elements to a gear-locking position using an elasticelement.

In some embodiments, the method further comprises closing a cover doorof the motor unit to release the interfering elements from thegear-locking position.

Unless otherwise defined, all technical and/or scientific terms usedherein have the same meaning as commonly understood by one of ordinaryskill in the art to which the invention pertains. Although methods andmaterials similar or equivalent to those described herein can be used inthe practice or testing of embodiments of the invention, exemplarymethods and/or materials are described below. In case of conflict, thepatent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and are notintended to be necessarily limiting.

Implementation of the method and/or system of embodiments of theinvention can involve performing or completing selected tasks manually,automatically, or a combination thereof. Moreover, according to actualinstrumentation and equipment of embodiments of the method and/or systemof the invention, several selected tasks could be implemented byhardware, by software or by firmware or by a combination thereof usingan operating system.

For example, hardware for performing selected tasks according toembodiments of the invention could be implemented as a chip or acircuit. As software, selected tasks according to embodiments of theinvention could be implemented as a plurality of software instructionsbeing executed by a computer using any suitable operating system. In anexemplary embodiment of the invention, one or more tasks according toexemplary embodiments of method and/or system as described herein areperformed by a data processor, such as a computing platform forexecuting a plurality of instructions. Optionally, the data processorincludes a volatile memory for storing instructions and/or data and/or anon-volatile storage, for example, a magnetic hard-disk and/or removablemedia, for storing instructions and/or data. Optionally, a networkconnection is provided as well. A display and/or a user input devicesuch as a keyboard or mouse are optionally provided as well.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

Some embodiments of the invention are herein described, by way ofexample only, with reference to the accompanying drawings. With specificreference now to the drawings in detail, it is stressed that theparticulars shown are by way of example and for purposes of illustrativediscussion of embodiments of the invention. In this regard, thedescription taken with the drawings makes apparent to those skilled inthe art how embodiments of the invention may be practiced.

In the drawings:

FIG. 1A is a simplified schematic side view of a surgical deviceincluding a plurality of arms, according to some embodiments of theinvention;

FIG. 1B is a simplified schematic of a device including a plurality ofarms, according to some embodiments of the invention;

FIGS. 1C-D are simplified schematic side views of surgical arms,according to some embodiments of the invention;

FIG. 2 is a simplified schematic of a device, held by a support,according to some embodiments of the invention;

FIGS. 3A-B are simplified schematic views of a system where a device isheld by a support, according to some embodiments of the invention;

FIG. 4A is a simplified schematic cross sectional view of an arm withnested segment extensions, according to some embodiments of theinvention;

FIG. 4B is a simplified schematic of a side view of a portion of an arm,according to some embodiments of the invention;

FIG. 4C is a simplified schematic cross sectional view of an arm withnested segment extensions, according to some embodiments of theinvention;

FIG. 5 is a schematic diagram of actuation of a surgical arm, accordingto some embodiments of the invention;

FIGS. 6A-D are various views of a motor unit for actuating a surgicalarm, according to some embodiments of the invention;

FIG. 7 is a flowchart of gear actuation for articulating a surgical arm,according to some embodiments of the invention;

FIGS. 8A-C are various view of an actuation mechanism, according to someembodiments of the invention. FIG. 8 c is a cross-section view takenalong a plane perpendicular to the longitudinal axis of the assemblyshown in the figure. In contrast, FIG. 8A is not a section view;

FIGS. 9A-D schematically illustrate, at a cross section, differentlayers of a structure of the actuation mechanism for articulating nestedarm segments, according to some embodiments of the invention;

FIGS. 10A-B illustrate clutch mechanisms, according to some embodimentsof the invention;

FIGS. 11A-B illustrate various configurations of an actuation mechanism,according to some embodiments of the invention;

FIG. 12A is a flowchart of a method for maintaining calibration of asurgical arm, according to some embodiments of the invention;

FIG. 12B illustrates a calibrated position of a surgical arm, accordingto some embodiments of the invention;

FIG. 12C is a cross section of the motor unit including a surgical arm(or extension thereof) received within the motor unit, according to someembodiments of the invention;

FIGS. 13A-E illustrate a mechanism for maintaining calibration of asurgical arm, according to some embodiments of the invention;

FIGS. 14A-B are an inner view of the motor unit (14A) and an outer viewof the motor unit (14B), according to some embodiments of the invention;

FIGS. 15A-B are cross section views of the motor unit showingsafety-related electrical components and position sensors, according tosome embodiments of the invention; and

FIG. 16 is a simplified side view of a portion of a motor unit includingelements for supplying electric power to an end effecter of the surgicalarm, according to some embodiments of the invention.

DESCRIPTION OF SPECIFIC EMBODIMENTS OF THE INVENTION

The present invention, in some embodiments thereof, relates to actuationof a device including at least one surgical arm and, more particularly,but not exclusively, to a motor unit configured for actuating at leastone surgical arm.

A broad aspect of some embodiments relates to actuation of a surgicalarm, and more particularly, but not exclusively, to motorized actuationof a surgical arm.

An aspect of some embodiments relates to actuating movement of a shaft(e.g. a segment of the surgical arm) having two degrees of freedom usingtwo actuators configured to interact with each other such that actuationof the first actuator indirectly manipulates one or more elongatedelements attached to the shaft and controlled by the second actuator. Insome embodiments, indirect manipulation comprises rotating the shaft,causing a change in a position of the elongated elements attached to theshaft.

In some embodiments, the first actuator is configured to rotate theshaft around the shaft axis. In some embodiments, the second actuator isconfigured to bend the shaft, for example by relative tensioning andreleasing of the elongated elements attached to the shaft, for exampleattached at a point distal to a flexible portion of the shaft. In someembodiments, rotation of the shaft by the first actuator tensions theelongated elements, thereby affecting operation of the second actuator,which controls the elongated elements. In some embodiments, the firstactuator is located between the second actuator and the attachment pointof the elongated elements to the shaft, such that the elongated elementsextend past the first actuator (e.g. pass from proximally to the firstactuator to distally of the first actuator).

In some embodiments, the actuator comprises a gear or a gear train. Insome embodiments, relative actuation of the actuators, comprising, forexample, rotating the gears at different speeds and/or directions,holding one gear stationary whilst the other gear is rotated isconfigured to actuate a first type of movement the shaft, for examplebending of the shaft. In some embodiments, unified actuation of theactuators, comprising, for example, rotating the gears at similarspeeds, is configured to actuate a second type of movement of the shaft,for example rotation of the shaft as a single rigid body.

In some embodiments, one or more elements such as a gear of a motordriving the actuator are configured to interfere with free rotation ofthe actuator. In some embodiments, an amount of resistance imposed onthe second actuator (e.g. friction due to the interfering motor gear)during actuation of the first actuator affects the type of movementproduced by actuation of the first actuator. For example, if theresistance is high enough to hold the second actuator stationary whilstthe first actuator is rotated, actuation of the first actuator willresult in simultaneous rotation and bending of the shaft. Alternatively,if low or no friction is encountered by the second actuator, rotation ofthe first actuator will in turn rotate the second actuator, resulting inrotation of the controlled shaft as a single rigid body.

In some embodiments, a threshold is applied for actuating a selectedmovement of the shaft, for example, the gears need to be rotated at aselected minimal speed in order to rotate the shaft as a rigid, singlebody.

An aspect of some embodiments relates to a shaft actuation mechanismcomprising two or more actuators movable about a similar rotationalaxis. In some embodiments, the rotational axis is the same as therotational axis of the shaft. In some embodiments, at least one of theactuators is configured to rotate the shaft about the common rotationalaxis. Optionally at least one other actuator is configured to producebending of the shaft and/or linear movement of the shaft.

An aspect of some embodiments relates to articulating a plurality ofshafts that are nested, at least in part, within one another. In someembodiments, articulation of an outer shaft requires simultaneousarticulation of an inner shaft positioned within the outer shaft. In anexample, in order to bend an outer shaft, an inner shaft nested at leastin part within the outer shaft is bent as well.

Some embodiments relate to a system comprising a motor unit configuredfor actuating movement of a surgical arm including a plurality of nestedshafts. In some embodiments, the motor unit comprises one more actuationmechanisms, configured for articulating (e.g. bending and/or rotating)at least a segment of the surgical arm. As referred to herein, an“actuation mechanism” may include one or more actuators, such as gear orgear trains, configured for actuating movement of a joint of thesurgical arm. In some embodiments, the actuation mechanism is configuredfor rotating an arm segment proximal to the joint around the segment'slong axis, as well as bending (flexing and/or extending) the joint. Inan embodiment, an actuation mechanism comprises a rotation gearconfigured at a distal end of the mechanism, and a bending gearconfigured at a proximal end of the actuation mechanism. In someembodiments, an outer shaft is operably attached to the rotation gearsuch that the rotation gear is configured to rotate the outer shaftaround the shaft long axis. In some embodiments, an inner shaft nestedwithin the outer shaft extends in a proximal direction to and throughthe bending gear, optionally continuing in the proximal direction to beoperably received within a second actuation mechanism, and so forth.

In some embodiments, the bending and rotation gear are driven indifferent manners, for example, in some embodiments, the bending gear isrotated by a second gear driven by a motor, while the rotation gear isdirectly driven by a motor. Additionally or alternatively, gears ofdifferent shapes and/or sizes (e.g. having different number of teeth)are used to drive the movement actuating gears. A potential advantage ofusing a gear train and/or gears of different sizes may include reducinga speed of the driving motor, increasing torque and allowing for ahigher degree of accuracy in control of arm movements. Additionally oralternatively, a selectable gear configured for modifying the motorspeed to a selected speed is used.

In some embodiments, a certain actuation speed is selected. In someembodiments, the speed is selected in accordance with a surgical actionperformed by the arm, for example performed by an end-effecter at adistal end of the arm. For example, in some embodiments, for actuationof an end-effecter of the arm such as grippers configured at a distalend of the arm, when actuating fast gripper movement, e.g. during tissuedissection, a high speed is selected; when actuating gripper movementwhich requires a relatively high amount of force to applied by thegripper, for example when stapling tissue, separating tissue and/orother actions associated with applying of a relatively high amount offorce via the grippers, a slower motor speed is selected. In someembodiments, articulation of a joint of the surgical arm involvesactuating different combinations of actuators, for example, rotation ofan elbow joint is obtained by a combination of 4 actuators, whileflexion of the elbow joint is obtained by a single actuator. In someembodiments, articulation of two or more joints is performedconcurrently, for example, when bending the shoulder, bending of theelbow is actuated as well so as not to limit bending of the shoulder.

In some embodiments, articulation is performed in accordance with acurrent position of the surgical arm. Optionally, the motor unitcomprises position sensors and/or is controlled by a processor,optionally including a memory which stores commands. In someembodiments, data from position sensor/s and/or from control memory isused to infer a position of the arm portion(s). In some embodiments, theprocessor receives signals from an input device (e.g. a joystick) and/orfrom a user motion detector device, and controls activation of the motorunit based on the received signals.

In some embodiments, a long axis of the motor unit is collinear with thelong axis of the surgical arm. In some embodiments, the plurality ofactuation mechanisms of the motor unit are aligned concentrically withrespect to each other, and/or with respect to the arm. In someembodiments, the prime actuators (e.g. motors) are shaped and sized tobe disposed in parallel to the actuation mechanism, optionally besideand/or beneath the actuation mechanism, to allow for a thin motor unit.

In some embodiments, the motor unit comprises a mirrored arrangement ofactuations mechanisms for actuating two surgical arms (optionallyimitating left and right human arms). Alternatively, the motor unit isconfigured for actuating a single arm. In some embodiments, a motor unitcomprising 3 actuation mechanisms, optionally driven by 6 motors, isconfigured to actuate a single arm, for example an arm comprising 3joints.

In some embodiments, the motor unit is of small dimensions, for examplea motor unit configured for actuating two arms comprises a width of lessthan 60 mm, less than 70 mm, less than 90 mm or intermediate, larger orsmaller size, and/or a length of less than 300 mm, less than 400 mm,less than 500 mm or intermediate, larger or smaller size. In someembodiments, during use, at least a portion of the surgical arm(s) isinserted into the body (through a natural body orifice and/or through anincised port), while the motor unit remains outside the body.Alternatively, the motor unit is small enough to be inserted, at leastin part, into the body.

An aspect of some embodiments relates to actuating linear movementdriven by rotational movement. In some embodiments, a threaded screw isconfigured to be rotated about its axis, for example by a gear (e.g. abending gear for example as described hereinabove), causing lateralmovement of one or more rider elements, such as half-nuts, that fitwithin the grooves defined by the thread and/or fit within indentationsdefined by radially-inward protrusions on the housing. In someembodiments, two half nuts are used, each of the half-nuts being coupledto an elongate element, so that rotation of the screw causes one halfnut to move distally and the other half nut to move proximally, therebycausing respective tensioning and releasing of the elongated elements.In some embodiments, a distal end of the elongated elements is attachedto a bendable shaft at a point distal to a flexible portion defining ajoint, and bending of the shaft is achieved by relative flexion andextension actuated by the linearly moved elongated elements.

In some embodiments, a coupling between the rotation gear and thethreaded screw comprises a clutch. In some embodiments, the clutchcomprises an elastic element such as a spring (e.g. a torsion and/ortension spring) which is coupled to the threaded screw, optionally at adistal end of the screw. Optionally, when torque and/or tension appliedby the rotated screw to the spring exceeds a certain threshold, thespring yields and further rotation of the screw is no longer effectiveto move the elongated elements. Additionally or alternatively, theclutch comprises a spring disposed at the attachment between theelongate element and the half nut. Optionally, when a pulling forceapplied to the elongated element via the spring exceeds a certainthreshold, the spring yields and further rotation of the screw is nolonger effective to move the elongated elements. In some embodiments,the clutch is operably coupled to an encoder configured to send a signalto a driver circuit controlling a motor actuating the rotation gear, forexample so that the motor is stopped in response to the signal.

An aspect of some embodiments relates to temporarily fixating a surgicalarm at a selected position, for example maintaining a calibrated stateof the surgical arm during attachment of the arm to a motor unit. Insome embodiments, movement of one or more movement actuating gears (e.g.bending and/or rotation gears) is limited or prevented, for example byelements configured to interfere with movement of the gear. In someembodiments, completion of the attachment process such as by closing acover door of the motor unit releases the interfering elements, allowingthe gears to rotate again.

An aspect of some embodiments relates to safety of a device comprisingone or more surgical arms. In some embodiments, the motor unit comprisesone or more mechanisms for reducing risk during a power outage, forexample: a solenoid lock which locks a cover of the motor unit duringpower outage; a manual mode in which the motor unit can be operatedmanually, for example by the surgeon; and/or other mechanisms configuredfor limiting manipulation of the arm and/or for limiting user access,for example during power outage.

In some embodiments, the motor unit comprise one or more mechanisms forreducing risk of human error during operation, for example, a relay thatprevents power delivery to an electrocautery instrument when theinstrument is mistakenly attached to the wrong device arm (e.g. in adevice comprising two arms, the electrocautery instrument being attachedto the arm defined as the left arm instead of the arm defined as theright arm or vice versa).

In some embodiments, the motor unit comprises one or more mechanisms forself-controlled operation, for example: cross-control of the motors inwhich a safety sensor of a first motor is controlled by a driver circuitcontrolling a second motor; selective delivery of monopolar or bipolarenergy to the end effecter using, for example, a slip ring, and/or otherenergy delivery control mechanisms.

In some embodiments, mechanisms and/or systems and/or methods forexample as described herein are used in robot-assisted surgeries and/orcomputer assisted surgeries. Robot-assisted surgeries may include, forexample, minimally invasive surgeries (e.g. surgeries in which a lessthan 5 cm incision is made, a less than 2 cm incision is made, a lessthan 1 cm incision or intermediate, larger or smaller incision is made);open surgical procedures; single port procedures; multi-port proceduresand/or other types of surgeries.

In some embodiments, mechanisms and/or systems for example as describedherein are configured to be controlled remotely. In some embodiments,the robot (comprising the one or more surgical arms for example asdescribed herein) is positioned on and/or below and/or otherwiseadjacent the operating table. In some embodiments, control of the one ormore surgical arms for example as described herein (e.g. arms as shownin FIGS. 1A-D and/or FIG. 2 and/or FIGS. 4A-C and/or FIG. 5 and/or FIG.6A and/or other figures described), is provided via a console which maybe located in the operating room, optionally adjacent the operatingtable and the surgical arms. Additionally or alternatively, control ofthe one or more surgical arms is performed from a distance.

A “robot” as referred to herein may include, in accordance with someembodiments, an electromechanical machine comprising one more surgicalarms for example as described herein, which are controlled by circuitry,for example controlled by a computer. In some embodiments, movement ofthe at least one surgical arm such as rotation of at least a portion ofthe arm; bending of the arm; axial movement of the arm (e.g. back andforth movement of the arm) and/or or other movements and/orarticulations for example as described herein are driven by one or moremotors operably coupled to the surgical arm.

In some embodiments, the robot is configured to carry out movementsassociated with surgery, for example movements that would have beenotherwise performed by a surgeon. In some embodiments, the robot isconfigured to control operation of surgical instruments inside and/oroutside the patient body, e.g. to actuate movement of an end effectersuch as a gripper.

Before explaining at least one embodiment of the invention in detail, itis to be understood that the invention is not necessarily limited in itsapplication to the details of construction and the arrangement of thecomponents and/or methods set forth in the following description and/orillustrated in the drawings and/or the Examples. The invention iscapable of other embodiments or of being practiced or carried out invarious ways.

Referring now to the drawings, FIG. 1A is a simplified schematic sideview of a device 100 (e.g. surgical device) including a plurality ofarms, according to some embodiments of the invention.

In some embodiments, the device includes a first arm 104 and a secondarm 102.

In some embodiments each arm 104, 106 includes a support segment 102,103, coupled to a first segment 112, 114 by a first connecting section108, 110, where first segment 112, 114 is coupled to a second segment116, 118 by a second connecting section 120, 122, and a third segment124, 126 coupled to second segment 116, 118 by a third connectingsection 128, 130.

In some embodiments, one or more of support segments 102, 103 are rigid.In some embodiments one or more of support segments 102, 103 areflexible or include a flexible portion.

In some embodiments, support segments 102, 103 are coupled, e.g. by acover 102 a. In some embodiments, support segments are coupled at only aportion of the torso length or are not coupled: FIG. 1B is a simplifiedschematic of a device 100 including a plurality of arms 104, 106,according to some embodiments of the invention.

In some embodiments, one or more arm includes a humanoid like structure.For clarity, in some portions of this document, device segments andconnecting sections are referred to by anatomical names: Supportsegments 102, 103 are also termed first torso 102 and second torso 103,first connecting sections 108, 110 are also termed first shoulder joint108, second shoulder joint 110, first segments, 112, 114 are also termedfirst humerus 112 and second humerus 114, second connecting sections120, 122 are also termed first elbow joint 120, and second elbow joint122, second segments 116, 118 are also termed first radius 116 andsecond radius 118 and third segments 124 and 126 are also termed firsthand tool 124 and second hand tool 126.

In some embodiments, one or more connecting section includes a hinge. Insome embodiments, one or more connecting section is flexible and/orincludes a flexible portion. In an exemplary embodiment, a device armincludes an elbow joint and a shoulder joint where bending of the jointis distributed along the joint in a direction of a joint long axis.

In some embodiments, torsos 102, 103 are close together, for example, along axis of first torso 102 and a long axis of second torso 103 arewithin 5 mm, or 3 mm, or 1 mm of each other. Alternatively, torsos 102,103 are spaced apart from each other. Additionally or alternatively,torsos 102, 103 are configured to converge or to diverge relative toeach other. Optionally, a torso is curved.

In some embodiments, one or more device segment has a substantiallycylindrical external shape (e.g. radius, humerus). In some embodiments,joints have circular long axis cross-section. Alternatively, in someembodiments, one or more device segment and/or joint has non-circularcross section external shape, for example, oval, square, rectangular,irregular shapes.

In some embodiments, a surgical arm includes one or more short and/oradjustable segment. In some embodiments, flexible portions are directlyconnected.

In some embodiments, a flexible portion comprises a plurality of stackedlinks.

FIGS. 1C-D are simplified schematic side views of surgical arms,according to some embodiments of the invention. FIG. 1C illustrates anexemplary embodiment where a humerus segment 112 is short, for example,the segment including a long axis length, J of 1-50 mm, or 1-35 mm, or10-20 mm, or approximately 10 mm or lower or higher or intermediateranges or lengths.

In some embodiments, a user selects arm\s including desired segmentlengths, where for example, selection is based on patient anatomy and/ora procedure to be performed. For example, when treating a child, a user,in some embodiments, selects one or more arm with one or more shortsegment (e.g. as illustrated by FIG. 1C). For example, when treating anobese patient, a user, in some embodiments, selects an arm with one ormore a long segment for example, a standard arm with a long humerussegment (e.g. as illustrated by FIG. 1D) (e.g. humerus segment length,J′ is 10-100 mm, or 20-35 mm, or 10-20 mm, or lower or higher orintermediate ranges or lengths).

In some embodiments, a device includes a kit with different structuredarms (e.g. different segment lengths, e.g. different arm sizes).

Alternatively or additionally, in some embodiments, one or more segmentlength is adjustable, e.g. during a treatment and/or during set-up ofthe device. For example, in some embodiments, the arm illustrated inFIG. 1C is adjustable (e.g. by telescoping of humerus segment 112) isadjustable to the configuration illustrated in FIG. 1D.

In some embodiments, extension and/or retraction of one or more segmentis effected by a portion connected to the segment (e.g. a segmentextension) being moved with respect to other portions of a surgical arm.For example, in some embodiments, a segment extension is moved (e.g. bya motor located in a motor unit) to increase a length of a segment. Insome embodiments, a motor uses a screw mechanism to move the segmentextension.

In some embodiments, a device arm has at least the freedom of movementof human arms. Generally, segments of human limbs (e.g. arms, legs) moveby flexion and extension from a proximal segment joint, and rotationaround the proximal segment joint. For example, a human radius flexesand extends at the elbow and rotates around the elbow.

The term proximal joint herein refers to the joint which is leastremoved from the torso to which a segment is coupled, e.g. a handproximal joint is the wrist, a radius proximal joint is the elbow joint,a humerus proximal joint is the shoulder joint.

The term proximal segment herein refers to the segment which is leastremoved from the torso to which a segment is coupled (e.g. by a proximalsegment joint). For example, a hand proximal segment is the radius, aradius proximal segment is the humerus, and a humerus proximal segmentis the torso.

In some embodiments, one or more joint is uni-directionally bendable andextendable. In some embodiments, segment rotation around a segmentproximal joint is achieved by rotation of a proximal segment around aproximal segment long axis. For example, rotation of the hand around thewrist joint is by rotation of the radius around a radius long axis.

Generally, human freedom of movement for arms includes limits to theangles of rotation and flexion. Optionally, in some embodiments, thedevice is restricted to human freedom of movements e.g. during one ormore control mode. Alternatively, the device is configured to allowmovement having additional degrees of freedom relative to human armmovement.

FIG. 2 is a simplified schematic of a device 200, held by a support 282,according to some embodiments of the invention.

In some embodiments, support 282 attaches to a portion of a patientoperating surface, e.g. rail 202. In some embodiments, position ofattachment of support 282 on rail 202 is adjustable, for exampleenabling linear adjustment of position of attachment of the support tothe patient operating surface. Optionally, the adjustment is performedmanually.

In some embodiments, support 282 is attached to port 212 of a motor unit214, device 200 being supported by attachment to motor unit 214.

In some embodiments, port 212 is placed at an opening to the patient'sbody, for example at an incision and/or at a natural body orifice suchas the vagina and/or anus and/or mouth. In some embodiments, port 212 isattached to the patient's body using sutures and/or other attachmentmeans. Additionally or alternatively, port 212 is fixated to theoperating surface 202.

In some embodiments, support 282 includes a plurality of articulationswhere angles between segments and/or segment lengths are adjustable, forexample, enabling adjustment of position and/or angle of a device 200including surgical arms and/or a port 212 and/or motor unit 214 (e.g.which actuate device 200 arm/s).

In some embodiments, one or more motor is used to move device 200, withrespect to one or more portion of the system (e.g. with respect to port212 and/or motor unit 214), for example, into and/or out of a patient.In some embodiments, motor unit 214 includes one or more motor formovement of one or more device arm with respect to the motor unit,where, for example, one or more support segment position is changed withrespect to the motor unit. In some embodiments, movement of device 200is controlled by a user, optionally using input object control and/or auser interface.

FIG. 3A is a simplified schematic view of a system 350 where a device300 is held by a support 382, according to some embodiments of theinvention.

In some embodiments, a device 300 is coupled to a bed 380. In someembodiments, a patient 360 lies on bed 380 for surgical procedures usingdevice 300. In some embodiments, one or more component of the device,for example one or more part of device control (e.g. motors) is locatedunderneath bed, e.g. in a housing 384. In some embodiments, support 382connects device 300 to housing 384. Optionally, other components, forexample transformers, connectivity to other components e.g. the display,are located in housing 384.

In an exemplary embodiment, a main motor unit for control of movement ofthe device is located in housing 384, where for example, in someembodiments, torque transfer element/s transfer torque from motor/swithin housing 384 to device 300 and/or elongated elements for effectingflexion of device joints are coupled to motors within housing 384.

In some embodiments, control of movement of the device above the bed,using a motor unit underneath the bed is via an orientation controller,for example using a parallelogram linkage, e.g. as described inInternational Patent Application Publication No. WO2011/036626 which isherein incorporated by reference into the specification in its entirety.

A potential benefit of one or more component being located underneath abed (e.g. inside housing 384), is reduced footprint of the system in anoperating room. A further potential benefit of components being locatedunderneath a bed as opposed to above and/or around the bed ispotentially improved access to a patient (e.g. in an emergencysituation).

A potential benefit of the device being coupled to a bed is the abilityto move and/or change an angle of the bed, for example, during surgery,while the device remains in the same position relative to the bed and/orpatient. Alternatively, or additionally, in some embodiments, a deviceposition with respect to the patient and/or the bed is adjustable, forexample, before treatment with the device and/or during surgery.

Optionally, in some embodiments, support 382 moves device into positionfor surgery. In some embodiments, support 382 moves device into adesired position for insertion into patient 360. In some embodiments,support 382 moves device vertically, and/or horizontally, and/orlaterally, and/or inserts device 300 into a patient 360 and/or withdrawsdevice 1100 from the patient.

In the embodiment illustrated by FIG. 3A, support arm 382 and housing384 are located at the foot end of 384. A potential benefit of thislocation is ease of surgery through a patient's undercarriage, forexample, through the vagina. In FIG. 3A, patient 360 is illustrated in asuitable position for insertion of the device into the vagina, thepatient's legs are elevated and apart (e.g. held by stirrups which arenot shown).

FIG. 3B is a simplified schematic view of a system 350 where a device300 is held by a support 382, according to some embodiments of theinvention. In the embodiment illustrated by FIG. 3B, support arm 382 andhousing 384 are located at a long axis center of the bed 380. Apotential benefit of this location is ease of abdominal and/or thoracicsurgery using the device.

In some embodiments, a housing position underneath the bed and/or aposition around the bed from where the arm meets the housing areadjustable. For example, the arm and/or housing are moved for differentsurgeries.

FIG. 4A is a simplified schematic cross sectional view of an arm 404with nested segment extensions, according to some embodiments of theinvention. FIG. 4B is a simplified schematic of a side view of a portionof an arm, according to some embodiments of the invention. Dashed linesillustrate the portion of the arm illustrated in FIG. 4A illustrated byFIG. 4B.

In some embodiments, arm 404 includes a hand tool 424 coupled to aradius 416 at a wrist joint 428.

In some embodiments, radius 416 is coupled to a radius extensionincluding two torque transfer portions; an elbow torque transfer portion416ETT disposed inside an elbow joint 420 and a shoulder torque transferportion 416STT disposed inside a shoulder joint 408. In someembodiments, radius 416 is coupled to a humerus 412 by a connector 416C.In some embodiments, portion 416C connects radius 416 to humerus 412whilst allowing free rotation of humerus 412. In some embodiments, atregion A of FIG. 4A, protrusion/s on radius portion 416 fit intoindentation/s on portion 416C. In an exemplary embodiment, a ring shapedprotrusion on radius portion 416 (e.g. a ring of material connected(e.g. welded) to radius portion 416) fits into an indentation on portion416C. Similarly, in some embodiments, portions 412C and 412 areconnected by matching protrusion/s and indentation/s (e.g. a ringprotrusion on portion 412 fitting into a matching indention in portion412C).

In some embodiments, a “connecting section” includes a connector and ajoint, for example shoulder joint 408 and connector 412C, and forexample elbow joint 420 and connector 416C.

FIG. 4C is a simplified schematic cross sectional view of a portion ofan arm, according to some embodiments of the invention. In someembodiments, for example, a portion includes a ring protrusion whichfits into an indentation on portion 416C.

In some embodiments, portion 416C provides anchoring to one or moreelongated element: for example, where elongated element/s (e.g. a cable,a wire, a tape) are connected/coupled to portion 416Canc.

In some embodiments, one or more connector couples portions whilstallowing one portion to rotate within the connector about the portion'slong axis. For example connecting portion 416C allows radius 416 torotate within connecting portion 416C about a radius long axis.

In some embodiments, humerus 412 is coupled to a humerus extensionincluding one torque transfer portion, a shoulder torque transferportion 412STT disposed inside shoulder joint 408. In some embodiments,the humerus is coupled to a torso 402 by a connector 412C.

In some embodiments, a surgical arm includes a first and a sectionflexible portion (e.g. elbow joint and shoulder joint) which are coupledtogether with a short connecting segment (e.g. a humerus sectioncoupling a shoulder and elbow joint is short). In some embodiments,coupling between the flexible portions is a point connection (e.g. ashoulder and elbow joint are directly connected).

In some embodiments, a rigid anchoring portion (e.g. portion 416C)connects two flexible portions, where the anchoring portion providesanchoring of elongated elements which control flexion and extension ofthe joint which is, for example, proximal to the elongated portion. Insome embodiments, anchoring is provided by a portion of one of thejoints, e.g. a distal portion of the proximal joint.

In some embodiments, one or more shafts (or portions thereof) of thesurgical arm are rigid. In some embodiments, a flexible shaft is nestedwithin a rigid outer shaft. In some embodiments, the outer shaft isflexible to a lower extent than the inner shaft.

FIG. 5 schematically illustrates actuation of a surgical arm 500,according to some embodiments.

In some embodiments, a proximally extending shaft extension 502 (e.g. anextension of a torso 503) of arm 500 is attached to a motor unit 504. Insome embodiments, proximal shaft extensions of arm segments that arenested within extension 502 (e.g. a proximal shaft extension 506 ofhumerus 507, a proximal shaft extension 508 of radius 509 that is nestedwithin humerus extension 506, a proximal shaft extension 510 of a handportion 511 that is nested within radius extension 508, and so forth)are actuated by a plurality of actuation mechanisms of the motor unit,such as 3 actuation mechanisms 520, 522 and 524. In some embodiments,the number of actuation mechanisms is set in accordance with the numberof joints of the arm, for example, as shown herein, an arm including 3joints (e.g. shoulder, elbow and wrist joints) is actuated by 3actuation mechanisms, an arm including 4 joints is actuated by 4actuation mechanisms, an arm including 2 joints is actuated by 2actuation mechanisms, an arm including 1 joint is actuated by a singleactuation mechanism.

In some embodiments, an actuation mechanism 520 (shown in the enlargedview) is configured to move at least a segment of arm 500, for examplerotate the segment and/or bend the segment and/or otherwise move thesegment. In some embodiments, an actuation mechanism comprises one ormore actuators, for example 1, 2, 3, 4, 5 and/or 6 actuators. In someembodiments, the actuators are independently operable, yet, in someembodiments, a shaft manipulation (e.g. rotation, bending) obtained by afirst actuator effects control of one or more other actuators.

In some embodiments, actuators of the same actuation mechanism areactuated together. Additionally or alternatively, actuators of differentactuation mechanisms are actuated together, for example to provide forarticulation of a proximal arm segment, a distal arm segment (which isat least partially nested within the proximal arm segment) needs to bemoved as well. In an example, to provide for flexion of the shoulder, abending actuator of an elbow is actuated as well.

In some embodiments, for example as shown herein, shaft extensions 502and 506 (which is nested, in part, within shaft extension 502) arereceived within actuation mechanism 520. In some embodiments, actuationmechanism 520 comprises a first actuator 540, and a second actuator 542.In some embodiments, first actuator 540 is configured to rotate an armportion, such as rotate the torso by rotating shaft extension 502 aroundits axis. In some embodiments, second actuator 542 is configured to bendan arm portion, such as bend a shoulder joint at a distal end of thetorso (not shown herein). Optionally, bending is achieved by respectivelinear movement of elongate elements 544 and 546, which extend fromactuator 542 and are connected distally to the joint.

In some embodiments, a prime mover of an actuator such as 540 and/or 542comprises a motor 532. In some embodiments, a speed of motor 532 rangesbetween, for example, 10-100 rpm, such as 20 rpm, 50 rpm, 70 rpm, 80 rpmor intermediate, higher or lower speeds. In some embodiments, motor 532is configured to apply a torque between 0.5 N*M to 3 N*m, such as 1 N*m,1.5 N*m, 2 N*m or intermediate, higher or lower values. In someembodiments, motor 532 is a continuous rotation motor.

Additionally or alternatively, a prime mover of an actuator comprises alinear motor. Additionally or alternatively, a prime mover of anactuator comprises a pulley. In some embodiments, the prime mover of anactuator is manually operated, for example comprising one or more cablesthat are pulled on to actuate movement of the gear.

In some embodiments, a single motor is configured to move more than oneactuator (e.g. rotate both the bending and rotation gears). In someembodiments, dual-actuation is enabled by use of a locking mechanism andanother motor configured for switching between the actuators, based onthe selected articulation (e.g. bending or rotation).

In some embodiments, motor 532 is positioned parallel to the shaftextension, for example underlying the shaft extension, overlying theextension and/or positioned beside the extension. Alternatively, motor532 is disposed within an internal lumen of the shaft extension.Alternatively, the shaft extension is configured as a part of the motor,for example contained within an external housing of motor 532.

In some embodiments, an actuator comprises a single gear or a geartrain. In some embodiments, the gear train is configured to amplify theinput torque generated by motor 532. Alternatively, the gear train isconfigured to reduce the input torque generated by motor 532. In someembodiments, the gear train is configured to reduce the rotation speedgenerated by the motor. In an example, the motor speed is 12,000 RPM,and the gear or gear train reduce the speed by a ratio of, for example,134:1, 43:1, 9:1 and/or intermediate, higher or lower ratios. In anexample, a gear or gear train actuating movement of an end-effecter ofthe arm such as grippers is configured to reduce the speed by a ratio of9:1, enabling fast opening and closure of the gripper. This may beadvantageous, for example, when dissecting tissue using the gripper.

Alternatively, in some embodiments, the gear train is configured toincrease the output speed generated by the motor. In an example, theoutput speed of the motor is increased for autonomous electricalablation of tissue.

In some embodiments, actuators of an actuation mechanism comprise gearsor gear trains that are different from each other. In some embodiments,the motors of the two actuators are rotated at similar speeds, but the“final” movement manipulating gears of each actuator are rotated atdifferent speeds. In an example, actuator 542 comprises a geartransmission while actuator 540 is driven directly by the motor. Inanother example, the actuators each comprise a single gear, but thegears are of different sizes and/or shapes (e.g. comprising differentnumber of teeth).

In an example, actuator 540 comprises a gear that is configured torotate shaft extension 502 directly, rotating at a speed, of, forexample, 2000 RPM; actuator 542 comprises a gear that is configured toactuate bending by linearly moving elongated elements 544 and 546,optionally by rotation of a threaded screw coupled to the elements forexample as described hereinbelow, and due to this additionaltransmission the gear of actuator 542 needs to rotated faster than gear540, for example rotated at a speed of 4000 RPM.

In another example, an actuator that actuates an end-effecter such as agripper is configured to rotate at a relatively fast speed, for example9000 RPM for enabling fast movement.

Alternatively, in some embodiments, it is desired to actuate anend-effecter at a relatively low speed, for example for action requiringapplying of relatively large force via the end-effecter, such asseparating tissue, stapling tissue, and/or other actions.

In some embodiments, actuators 540 and 542 are rotated on a singlerotational axis 548. In some embodiments, axis 548 is also therotational axis of shaft extensions 502 and 506.

In some embodiments, actuation mechanisms 520, 522, 524 of the motorunit are collinear.

In some embodiments, the motor unit includes one or more position sensor552.

In some embodiments, position sensor 552 is placed adjacent the motorfor sensing a current rotation angle of the motor.

In some embodiments, the position sensor is magnetically operated, usinga magnet placed on the motor gear and sensing the magnetic flux todetermine a current position of the motor gear.

In some embodiments, the motor unit is controlled by a processor 550including a memory which stores commands.

In some embodiments, data from position sensor/s and/or from controlmemory is used to infer a position of device portion/s.

In some embodiments, the motor unit is controlled by a processorconfigured in the user's input device.

In some embodiments, motor unit 504 includes structure (e.g. includingelectrical contact/s), for example, for delivery of monopolar and/orbipolar energy to the device (e.g. to a device end effecter), forexample as further described in FIG. 16 .

FIG. 6A is a simplified schematic side view of a motor unit 600 foractuation of a device including surgical arms, according to someembodiments of the invention. In some embodiments, a device including afirst surgical arm 604 and a second surgical arm 606 are controlled bymotor unit 600.

FIG. 6B is a detailed view of the motor unit 600, according to someembodiments.

In some embodiments, a first actuation mechanism 601 a, including firstrotation gear 602 a and first bending gear 606 a, drivesflexion/extension and rotation of a shoulder joint. Referring now toFIGS. 4A-B, for example, in some embodiments, first actuation mechanism601 a rotates the shoulder joint by rotating torso 402 and effectsflexion and extension of shoulder joint 408 by movement of elongatedelements attached to connector 412C.

In some embodiments, a second actuation mechanism 601 b, includingsecond rotation gear 602 b and second bending gear 606 b, drivesflexion/extension and rotation of an elbow joint.

In some embodiments, one or more driving gear coupled to a motor 670 isdisposed underneath motor unit 600. For example, in some embodiments, agear which drives second bending gear 606 b, which gear is coupled to amotor is disposed on an underside of motor unit 600. For example, gear699 drives a second actuation mechanism corresponding to second surgicalarm 606. Referring now to FIGS. 4A-B, for example, in some embodiments,second actuation mechanism 601 b rotates the elbow joint by rotatinghumerus 412 and effects flexion and extension of elbow joint 420 bymovement of elongated elements attached to portion 416C.

In some embodiments, a third actuation mechanism 601 c, including thirdrotation gear 602 c and third bending gear 606 c, actuates an endeffecter (e.g. opens and closes a gripper) and drives rotation of awrist joint. Referring to FIG. 4A, in some embodiments, rotation gear602 c rotates radius 416 and bending gear 606 c actuates hand tool 424;For example, in some embodiments, rotation of third bending gear 606 copens and closes an end effecter.

In some embodiments, similarly, second surgical arm 606 is actuated bythree actuation mechanisms, including, for example, 6 motors. In anexemplary embodiment, a device for insertion into the body includes twosurgical arms, actuated by 12 motors.

In some embodiments, one or more additional motor (e.g. a 13th motor)moves the device arms towards and/or away from the motor unit. Forexample, in some embodiments, a position of attachment of the motor unit(e.g. to a support and/or to a patient support surface) is changed e.g.by a motor.

In some embodiments, the device comprises a single arm actuated by amotor unit comprising 6 motors (e.g. 2 motors per each actuationmechanism). In some embodiments, a 7^(th) motor is used for linearlymoving the arm, for example towards and/or away from the motor unitand/or from the patient's body.

In some embodiments, one or more additional motors (e.g. an 8^(th)motor, a 9^(th) motor) are used. Optionally, the additional motor(s)actuate movement of an end-effecter of the arm around a pivot point(fulcrum movement), for example around the incision.

For example, referring to FIG. 2 , in some embodiments, a position ofattachment of support 282 with respect to rail 202 is changed (e.g. by amotor located on support 282). For example, in some embodiments, aposition of attachment of motor unit 214 with respect to support 1482 ischanged (e.g. by a motor located on support 282).

For example, moving the device into and/or out of a patient body e.g.when the motor unit is supported in a fixed configuration and/or toautomate movement of the device into the patient. In some embodiments, amotor located within motor unit 600 moves the device arms into and/orout of a patient.

In some embodiments, for example, so that rotation of a joint alsocauses rotation of joints distal of the rotated joint, more than oneactuation mechanism is driven in rotation of the joint. For example, insome embodiments, for rotation of the shoulder joint, gears 602 a, 606a, 602 b, 606 b, 602 c, 606 c are rotated in the same direction. Forexample, in some embodiments, for rotation of the elbow joint, gears 602b, 606 b, 602 c, 606 c are rotated in the same direction. For example,in some embodiments, for rotation of the end effecter, gears 602 c, 606c are rotated in the same direction.

In some embodiments, concurrent rotation of nested portions with outerportions prevents stress on and/or tangling of internal elongatedelements (e.g. elongated element/s which are used to effectflexion/extension, e.g. elongated element/s providing power supply).

In some embodiments, one or more actuation mechanism is used toflex/extend a joint. For example, in some embodiments, to bend ashoulder joint, elongated elements for bending of both the shoulderjoint and elbow joint are moved, for example by actuating bending gear606 a and bending gear 606 b.

In some embodiments, if elongated elements for the elbow are not movedand/or released, tension in the elongated elements associated with theelbow joint resist movement of the shoulder joint.

In some embodiments, a motor unit is small, for example having a longaxis length 650 of between 100-600 mm, or 200-400 mm, or 300-500 mm, or150-400 mm, or intermediate, longer or shorter length. In someembodiments, a width 652 of the motor unit (e.g. as measuredperpendicular to the long axis) is between 20-100 mm, or 30-80 mm, or50-70 mm, or intermediate, longer or shorter width.

In some embodiments, motor 670 is cylindrical. Optionally, a diameter ofmotor 670 is less than 17 mm, less than 35 mm, less than 10 mm orintermediate, larger or smaller diameters. A potential advantage ofdisposing a motor of a relatively small diameter in a parallel positionrelative to the arm may include maintaining the dimensions of the motorunit small.

Alternatively, the motor is not cylindrical, for example rectangular. Insome embodiments, the motor comprises a hollow shaft. A potentialadvantage of a hollow shaft may include reducing the footprint of thesystem in the operating room.

In some embodiments, electric power is supplied through wires to themotor unit, for example, in some embodiments, contacts 620 are connectedto an electric power supply. The electric power supply may include abattery (optionally rechargeable) and/or a generator and/or connectionto the electrical network via a wall socket and/or a combinationthereof. In some embodiments, the power range is between 100-300 W, forexample 150 W, 200 W, 250 W or intermediate, higher or lower ranges. Insome embodiments, an uninterruptible power supply source is used toprotect from power interruptions.

In some embodiments, a motor unit drives more than two surgical armsand/or drives additional device elements. For example, in someembodiments, a motor unit drives two device arms and a camera.

FIG. 6C is a cross-section of the motor unit along the length of theunit, showing actuation mechanisms of a single surgical arm, accordingto some embodiments. In some embodiments, the motor unit comprises amotherboard 622, optionally underlying the actuation mechanisms. In someembodiments, one or more driver circuits 624 are operably coupled tomotherboard 622 for controlling operation of the motor unit. In someembodiments, each driver circuit is configured to control activation ofone of the motors (e.g. one of the 6 motors described hereinabove). Insome embodiments, cross-control of the motors is provided. In anexample, a position sensor of a first motor is controlled by acontroller of a second motor. Optionally, in such configuration,malfunctioning of the first motor, position sensor associated with thefirst motor and/or driver controlling the first motor can be detected bythe controller of the second motor.

In some embodiments, an external housing 626 of the motor unit comprisesa handle 628 for attaching and/or releasing arm 604 from a distal endface 630 of the motor unit.

In some embodiments, one or more latches 632 are configured on externalhousing. Optionally, latch 632 is configured to release a gear fixationmechanism used, for example, during attachment of the surgical arm tothe motor unit to maintain calibration of the motor unit, for example asfurther described herein.

FIG. 6D is a cross section of the motor unit along an axis perpendicularto the long axis, according to some embodiments.

In some embodiments, the motor unit is configured to actuate twosurgical arms; in this example, one surgical arm 604 (an extension ofwhich) is shown to be received within a first side of the motor unit,while the second opposing side is shown in a configuration suitable forreceiving a second arm, for example within internal lumen 640.

It is noted that in some embodiments a motor unit configured foractuating a single arm is comprised of only of one of the sides of themotor unit shown herein, including, for example, 3 actuation mechanisms.

In some embodiments, for example as shown herein, actuation gears 672and 676 of motors 670 and 674 respectively are each configured to drivea gear of an actuation mechanism, for example actuation gear 672 ofmotor 670 is configured to drive rotation gear or bending gear 678 (suchas gear 602 a or 606 a or 602 b or 606 b or 602 c or 606 c).

In some embodiments, latch 632 configured at the first side of the motorunit in which the arm is received is shown at a closed position, whichreleases a fixation mechanism of gear 678, allowing it to rotate freely;a second latch 634 configured at the second side of the motor unit,shown without an arm, is shown at an open, lifted position.

In some embodiments, a motor such as 674 is disposed such that it doesnot extend to a distance 682 longer than 5 mm, 10 mm, 20 mm orintermediate, longer or shorter distances relative to a central longaxis of an actuation mechanism, for example passing through a center 680of rotation/bending gear. A potential advantage of a motor disposedadjacent an actuation mechanism, optionally in parallel to the actuationmechanism such that it substantially does not protrude outwardly orprotrudes outwardly to a short distance only may include reducingbulkiness of the motor unit, potentially allowing insertion of thesurgical arm(s) as well as the motor unit into the body duringoperation.

In some embodiments, the motor unit is coupled to a linear unit 680,configured for actuating linear movement of the motor unit (and therebyof the arm(s)), for example actuate advancement and/or retraction of thedevice to and/or from the patient body. In some embodiments, linear unit680 comprises a rail 682 on which a sliding element 684 coupled to themotor unit can be moved linearly. In some embodiments, movement (e.g.sliding) of the motor unit on the rail of the linear unit is actuated bya motor.

Alternatively, in some embodiments, the linear unit is an integralcomponent of the motor unit.

In some embodiments, the linear unit comprises one or more sensors, suchas microswitches, for detecting movement of the motor unit. In someembodiments, the linear unit comprises one or more actuation buttonsconfigured to provide for a user (e.g. nurse) to move the motor unitaccording to the need. In some embodiments, the motor driving the linearmovement (not shown herein) comprises an electro-magnetic break.Optionally, the brake is configured to avoid unwanted movement (e.g.slipping) of the motor unit, for example during a power outage.

FIG. 7 is a flowchart of exemplary operation of an actuation mechanismcomprising a rotation gear and a bending gear, according to someembodiments.

In some embodiments, actuation of a gear comprises actively rotating thegear at a certain speed and/or direction, for example by the motor. Insome embodiments, actuation of the bending gear (700) generates bendingof the joint (702), for example by simultaneous flexion and extension.Optionally, simultaneous flexion and extension is obtained by relativetensioning and releasing of elongated elements extending along the armsegment being moved and connected at a point distal to the joint (e.g.flexible segment).

In some embodiments, an articulation actuated by rotation gear (704)depends on movement of the bending gear. In some embodiments, forexample when the arm is placed in the motor unit, free rotation of thebending gear is resisted at least in part by a gear that drives thebending gear, for example in some embodiments the motor gear or a secondgear driven by the motor gear. Optionally, in such situation, actuationof the rotation gear whilst the bending gear is held stationarygenerates rotation of an arm segment proximal to the joint as well asbending of the joint (706).

In some embodiments, when no resistance is imposed on the bending gear,actuation of the rotation gear will bring about rotation of the bendinggear, resulting in rigid “single body” rotation of the arm (707).

In some embodiments, both gears are actuated together.

In some embodiments, relative actuation of the gears (708), including,for example: holding the bending gear stationary and rotating therotation gear; rotating the gears at different speeds and/or directionsgenerates bending (710).

In some embodiments, unified actuation of both gears (712), i.e.rotating the bending gear and the rotation gear at the same speed anddirection generates “single body” rotation (714), in which the actuatedarm segment moves as a whole.

In some embodiments, a bending gear and/or rotation gear of more thanone actuation mechanism (e.g. 2, 3, 5) are actuated simultaneously.Optionally, actuation of more distal, nested arm portion(s) is performedso as to allow movement of a more proximal arm portion. For example,when bending the shoulder joint, bending gears of both the shoulder andthe elbow are actuated (e.g. 606 a, 606 b) so as to release tension fromthe elongate element operating the elbow which will in turn allow forbending of the shoulder. In an example, if 606 a was to be solelyrotated to bend the shoulder, a tensioned elongate element operating theelbow may tear.

FIG. 8A is a simplified schematic side view of an actuation mechanismfor control of a surgical arm joint, according to some embodiments ofthe invention.

In some embodiments, a rotation gear 802 is coupled to a shaft 804,where shaft 804 is coupled to an extension (e.g. to torso 402, FIG. 4A).In some embodiments, rotation of rotation gear 802 causes rotation ofshaft 804 which in turn rotates the distal extension coupled to theshaft.

In some embodiments, a shaft 880 which is nested, at least in part,within shaft 804 extends in the proximal direction to a bending gear806.

In some embodiments, bending gear 806 is coupled to a portion includingscrew threading, referred to herein as threaded screw 808. In someembodiments, a threading on screw 808 comprises a double thread. In someembodiments, rotation of the double thread in one direction achievesbidirectional lateral movement of one or more rider elements, such ashalf-nuts referred to hereinbelow, coupled to the screw.

In some embodiments, a pitch 882 of the screw thread is selectedaccording to the use of the arm. For example, a small thread pitch ismore advantageous when the arm is configured to operate large loads, forexample a load of 2000 grams, 1500 grams, 3000 grams or intermediate,larger or smaller loads at a low speed (e.g. 0.5 rounds per second, 1round per second, 0.2 rounds per second). Alternatively, a large threadpitch is more advantageous when the arm is configured to operate smallloads, for example 100 grams, 50 grams, 300 grams or intermediate,larger or smaller loads at a higher speed (e.g. 2.5 rounds per second, 4rounds per second, 5 rounds per second).

In some embodiments, rotation of the bending gear 806 causes rotation ofthreaded screw 808. In some embodiments, a first half nut 810 and asecond half nut 812 are coupled to screw threaded screw 808 such thatrotation of the screw threading generates linear movement of half-nutsparallel to a long axis 814 of central shaft 804, where first half-nut810 and second half-nut 812 move in different directions.

In some embodiments, each of the half-nuts is limited to movement in asingle direction, for example a right handed half-nut and a left handedhalf-nut. In some embodiments, movement of the half-nuts is limited byone or more protrusions, for example protrusions extending radiallyinward from an inner wall of housing 816, for example as furtherdescribed herein.

In some embodiments, first half nut 810 and second half nut 812 areconnected to elongated elements 810 ee and 812 ee respectively, wherelinear movement of the nuts pulls one elongated element whilst releasingand/or pushing on the other, generating flexion/extension of the joint.In some embodiments, a distance 820 between the half-nuts, measuredalong an axis perpendicular to the long axis, defines the distancebetween the elongated elements. In some embodiments, distance 820between the elongated elements remains constant. In some embodiments,first nut 810 is configured remain in line with elongated element 810ee, and second nut 812 is configured to remain in line with elongatedelement 812 ee.

In some embodiments, an elongated element such as 810 ee and/or 812 eecomprises a wire, cable, ribbon, tape and/or any other element which canbe tensioned and released to provide for bending of the joint.

It is noted that in some embodiments, only one elongated element isused. In an example, the mechanism comprises one elongated element andan elastic element such as a spring. Optionally, the spring isconfigured to move relatively to the elongated element, for example ifthe elongated element is flexed, the spring is extended and vice versa.It is also noted that in some embodiments, more than two elongatedelements (e.g. 3, 4, 6, 8) may be used.

In some embodiments, actuation of the rotation gear rotates the armsegment and thereby pulls on the elongated elements, moving thehalf-nuts. If the bending gear is held stationary (e.g. by the motorgear), the threaded screw will not rotate, generating simultaneousrotation and bending of the arm segment. If the bending gear is free torotate, pulling on the elongated elements will in turn move thehalf-nuts, rotating the threaded screw. Friction at interface 884between a head of the threaded screw and bending gear 806 will in turnrotate the bending gear, generating rotation of the arm segment as onepiece.

In some embodiments, one or both of the elongated elements is coupled toan elastic element such as a spring. Optionally, the spring isconfigured to limit tensioning of the elongated element(s), yielding inresponse to a force (e.g. torque and/or pulling force) above a certainthreshold.

FIGS. 8B-C are cross section views of the actuation mechanism along thelong axis (8B) and along an axis perpendicular to the long axis (8C).FIG. 8B show housing 816 extending between rotation gear 802 and bendinggear 806. Threaded screw 808 and half-nuts 810 and 812 are shown at across section. FIG. 8C, viewed from a proximal to distal direction,shows radially inward protrusions 82 d which are configured to limitrotational movement of the nuts, for example so as to keep a constantcross-distance between the half-nuts, for example during rotation ofthreaded screw 808.

In some embodiments, elongated elements 810 ee and/or 812 ee arepositioned within designated elongated grooves 850 configured in housing816 (see FIG. 8C) such that actuation of rotation gear 802 does nottwist the elongated elements about the long axis of the actuationmechanism. Optionally, a cross-wise position of the elongated elementsrelative to each other is maintained constant.

In some embodiments, housing 816 covers the central shaft, screwthreading and nuts, for example, potentially preventing debris or othermaterial from entering the mechanism. In some embodiments, housing 816is cylindrical.

In some embodiments, each mechanical device joint is coupled to anactuation mechanism as described above (e.g. by an extension coupled tothe joint). For example, in some embodiments, each extension portion(e.g. as describe above) is coupled to a central shaft, and elongatedportions for control of flexion and extension (e.g. as described above)are coupled to half-nuts of the actuation mechanism.

In some embodiments, actuation mechanisms for a single surgical arm arearranged linearly, with central shafts disposed in a nestedconfiguration, the inner central shafts protruding for control by thegears.

FIGS. 9A-D schematically illustrates, at a cross section, differentlayers of a structure of the actuation mechanism for articulating nestedarm segments, according to some embodiments. In FIG. 9A, an extension900 of the shoulder (e.g. a torso for example as shown in FIG. 4A) isoperably received within a rotation gear 902 of a first actuationmechanism 912, according to some embodiments. FIG. 9B illustrateselongated elements 904 and 906 for actuating bending of the shoulder inresponse to rotation of threaded screw 908, according to someembodiments. In FIG. 9C, an extension 910 of the elbow (e.g. anextension of a humerus 412 for example as shown in FIG. 4A), which isnested, at least in part, inside extension 900 of the shoulder, isreceived within an internal lumen of threaded screw 908. In someembodiments, elbow extension 910 is freely received within threadedscrew 908 such that rotation of the screw does not affect rotation ofelbow extension 910. FIG. 9D illustrates a proximal portion of elbowextension 910 operably received within a rotation gear 914 of a secondactuation mechanism 920, aligned proximally (and, in some embodiments,linearly) relative to first actuation mechanism 912. Optionally, in thismanner, additional nested extensions (e.g. a wrist extension such asradius 416) are freely received within a more proximal actuationmechanism and operably received within a more distal actuationmechanism.

FIGS. 10A-B illustrates a clutch mechanism, according to someembodiments of the invention.

In some embodiments, an elastic element such as a spring is used forsetting a minimal and/or maximal actuation force, according to someembodiments.

In some embodiments, as shown for example in FIG. 10A, threaded screw1000 is coupled to a central spring 1002. In some embodiments, rotationof screw 1000 applies torque and/or tension to spring 1002. Optionally,when the applied force tensions (e.g. linearly pulls and/or twists)spring 1002 beyond its elastic limit, the spring yields and furtherrotation of screw 1000 is no longer effective to move elongated elements1004 and 1006 (shown in FIG. 10B).

Additionally or alternatively, one or both of the elongated elements iscoupled to an elastic element such as a spring 1008, for exampleattached between a proximal end of the elongate element and the half-nut1010. In some embodiments, rotation of screw 1000 actuates linearmovement of the elongated elements, for example pulling elongatedelement 1004. Optionally, when an elongate element such as 1004 istensioned above a certain threshold, spring 1008 yields and rotation ofthe screw is no longer effective to move (e.g. pull proximally) theelongate element.

FIGS. 11A-B illustrate various configurations of an actuation mechanism,according to some embodiments.

FIG. 11A illustrates a configuration in which three actuators 1102 areconfigured to manipulate a shaft 1100 (or a distal extension thereof).In some embodiments, actuators 1102 include, for example, a rotationactuator, a bending actuator, a linear actuator configured to move theshaft back and forth, or combinations thereof (for example, two bendingactuators and one rotation actuator, etc).

FIG. 11B shows a telescopic configuration in which, for example, anactuator 1104 is configured to extend shaft portions distally and/orapproximate shaft portions proximally, for example using elongatedelements 1106 attached to a protruding end of a shaft 1108.

In some embodiments, an actuator 1110 is shaped and/or sized such thatthe shaft or only some portions thereof is slidably received in it, forexample the shaft or portion thereof can be moved back and forth throughthe actuator.

FIG. 12A is a flowchart of a method for maintaining calibration of asurgical arm, according to some embodiments of the invention.

In some embodiments, surgical device arms are initialized to a straightposition, in which segment long axes are parallel (e.g. collinear), forexample as shown in FIG. 12B. Optionally, a direction of bending 1200 offirst arm segment 1202 is lined with a direction of bending 1204 ofsecond arm segment 1206.

In some embodiments, surgical device arms are provided in a straightposition e.g. factory calibrated to a straight position. In someembodiments, a jig is used to straighten surgical device arm/s.

In some embodiments, a configuration of the actuation mechanism(s) isset in accordance with the calibrated configuration of the arm, forexample, the gears are rotated to a position in which all arm portionsare straightened relative to each other.

In some embodiments, one or more mechanisms are provided for maintaininga calibrated position of the arm, for example during insertion of thearm (or extensions thereof) to the motor unit 1212, for example as shownin FIG. 12C. In some cases, arm extensions may be unintentionallyrotated, for example when moved against the motor gear 1214 duringinsertion. In some embodiments, one or more mechanisms are provided toprevent such movement.

Optionally, during insertion, motor gear 1214 is allowed to move (forexample so as not to interfere with advancement of the arm (orextensions thereof) proximally), and once the arm is seated in position,the motor gear is locked until further activation. In some embodiments,motor gear locking and/or releasing is electrically controlled by amicro-switch connected to the motor.

In the exemplary mechanism described herein, actuation mechanism(s) ofthe arm are temporarily fixated (1208). In some embodiments, temporaryfixation is achieved by one or more elements configured to interferewith rotation of the gears (e.g. rotation and/or bending gears).

In some embodiments, for example once the arm is fully received withinthe motor unit, the temporary fixation of the gears is released (1210).Optionally, fixation is released in response to manual operation by theuser, for example closure of a cover door of the motor unit. In someembodiments, the interfering elements are moved away from the gears, forexample using spring-based actuation.

In some embodiments, the motor unit comprises one or more calibrationdiscs, configured for indicating whether a gear has moved, for exampleduring insertion of the arm.

FIGS. 13A-E illustrate a mechanism for maintaining calibration of asurgical arm, according to some embodiments.

In some embodiments, for example during insertion of arm 1300 to themotor unit 1302, interfering elements 1304 are moved to a position inwhich they lock gears of the actuation mechanism (e.g. gears 1306,1308), preventing the gears from rotating, for example as shown in FIGS.13A and 13B. Optionally, the interfering elements are moved to thelocking position by a spring and/or other elastic element 1320(positioned behind interfering element 1304).

In some embodiments, a lever 1310 is coupled to the interferingelements. Optionally, when lever 1310 is pushed on, for example as shownin FIG. 13C, the interfering elements are moved to a position in whichthey no longer interfere with rotation of the gears.

In some embodiments, lever 1310 is pushed on (and/or elevated) inresponse to closure of a cover door 1312 of the motor unit, for exampleas shown in FIG. 13D. Optionally, locking of latches 1314 (optionallymanually, e.g. by a physician or a nurse) applies pressure onto lever1310, releasing the interfering elements from the gears to provide forarticulation of the arm.

FIG. 13E shows an interfering element comprising an elastic element 1330which springs into a locked or released position.

FIG. 14A is a view of the motor unit 1400 showing an exposed innerportion of the motor unit, according to some embodiments. FIG. 14B showsan outer view of the motor unit in which a cover door of the motor unitis open.

In some embodiments, a user (e.g. physician and/or nurse) is providedwith internal access to the motor unit. In some embodiments, for exampleduring a power outage, manual override by the physician is enabled.Optionally, the user can access the motor(s), for example to manuallyoperate to the motor gear 1404. In some embodiments, one or moredirecting arrows 1402 are marked on the motor unit housing, optionallyindicating a rotation direction in which the gears need to be rotated inorder to straighten the arm.

In some embodiments, the cover door of the motor unit 1406, see FIG.14B, is configured to automatically lock, for example during poweroutage. Optionally, a solenoid bolt 1408 locks the cover door.Optionally, the solenoid lock mechanism can be manually overridden, forexample by opening the cover door to allow access to at least some ofthe internal components of the motor unit.

In some embodiments, the solenoid lock mechanism is configured toprevent unintended removal of the arm(s) from the motor unit. In anexample, cover door 1406 cannot be opened until solenoid 1408 isreleased, for example by the physician, optionally via the user inputdevice.

In some embodiments, control of arm insertion and/or removal is limitedto a user, for example only the physician can control opening and/orlocking of the solenoid lock mechanism, for example via the user inputdevice.

In some embodiments, for example during a power outage, power supply isprovided by a battery.

FIGS. 15A-B are examples of safety-related electrical components of themotor unit, according to some embodiments.

Referring to FIG. 15A, in some embodiments, cross-control over motoractivation is provided. In some embodiments, a safety sensor 1500 isoperably coupled to a first motor 1502. In some embodiments, controlover safety sensor 1500 (e.g. on/off activation) is performed by acontroller of a second motor, for example motor 1504. Optionally, thecontroller detects malfunction of the first motor.

Referring to FIG. 15B, in some embodiments, power delivery to the arm(e.g. to an electrocautery instrument attached at a distal end of thearm) is controlled with the aid of a relay 1506. Optionally, relay 1506restricts current delivery when the electrocautery instrument ismistakenly attached to an arm, for example attached to the left arminstead of the right arm or vice versa. In an example, a physiciandefines (optionally via the user input device) that monopolar energy isdelivered to an arm defined as the right arm, and bipolar energy isdelivered to an arm defined as the left arm. Optionally, relay 1506 isconfigured to detect a mismatch, for example that the bipolarelectrocautery tip was attached to the arm defined as the right arminstead of the arm defined as the left arm, and the electric current isceased.

FIG. 16 is a simplified side view of a portion of a motor unit includingelements for supplying electric power to an end effecter of the surgicalarm, according to some embodiments of the invention. In someembodiments, one or more mechanisms are incorporated in the motor unitfor ensuring that the electric power supply is not effected by a currentposition arm position. Alternatively, the electric power supply iseffected by a current arm position.

In some embodiments, portion 1630 is coupled to an end effecter suchthat, when 1630 is rotated, it rotates an end effecter, for example,portion 1620 is coupled to hand tool 424 of FIG. 4A. In someembodiments, gear 1632 actuates the end effecter, for example, rotationof gear 1632 opens and/or closes jaws of a grasper end effecter. In someembodiments, contacts 1622 and 1624 provide electric power to ringportions 1626 and 1628 respectively. In some embodiments, one ofcontacts 1622, 1624 provides positive voltage and the other negative,providing bipolar power supply. In some embodiments, each of ringportions 1626 and 1628 are electrically connected (e.g. through wiresrunning through 1630) to an end effecter, where one of the ring portionsis coupled to one side of a grasper and the other to the other side of agrasper.

The terms “comprises”, “comprising”, “includes”, “including”, “having”and their conjugates mean “including but not limited to”.

The term “consisting of” means “including and limited to”.

The term “consisting essentially of” means that the composition, methodor structure may include additional ingredients, steps and/or parts, butonly if the additional ingredients, steps and/or parts do not materiallyalter the basic and novel characteristics of the claimed composition,method or structure.

As used herein, the singular form “a”, “an” and “the” include pluralreferences unless the context clearly dictates otherwise. For example,the term “a compound” or “at least one compound” may include a pluralityof compounds, including mixtures thereof.

Throughout this application, various embodiments of this invention maybe presented in a range format. It should be understood that thedescription in range format is merely for convenience and brevity andshould not be construed as an inflexible limitation on the scope of theinvention. Accordingly, the description of a range should be consideredto have specifically disclosed all the possible subranges as well asindividual numerical values within that range. For example, descriptionof a range such as from 1 to 6 should be considered to have specificallydisclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numberswithin that range, for example, 1, 2, 3, 4, 5, and 6. This appliesregardless of the breadth of the range.

Whenever a numerical range is indicated herein, it is meant to includeany cited numeral (fractional or integral) within the indicated range.The phrases “ranging/ranges between” a first indicate number and asecond indicate number and “ranging/ranges from” a first indicate number“to” a second indicate number are used herein interchangeably and aremeant to include the first and second indicated numbers and all thefractional and integral numerals therebetween.

As used herein the term “method” refers to manners, means, techniquesand procedures for accomplishing a given task including, but not limitedto, those manners, means, techniques and procedures either known to, orreadily developed from known manners, means, techniques and proceduresby practitioners of the chemical, pharmacological, biological,biochemical and medical arts.

As used herein, the term “treating” includes abrogating, substantiallyinhibiting, slowing or reversing the progression of a condition,substantially ameliorating clinical or aesthetical symptoms of acondition or substantially preventing the appearance of clinical oraesthetical symptoms of a condition.

It is appreciated that certain features of the invention, which are, forclarity, described in the context of separate embodiments, may also beprovided in combination in a single embodiment. Conversely, variousfeatures of the invention, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable subcombination or as suitable in any other describedembodiment of the invention. Certain features described in the contextof various embodiments are not to be considered essential features ofthose embodiments, unless the embodiment is inoperative without thoseelements.

Although the invention has been described in conjunction with specificembodiments thereof, it is evident that many alternatives, modificationsand variations will be apparent to those skilled in the art.Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the appended claims.

All publications, patents and patent applications mentioned in thisspecification are herein incorporated in their entirety by referenceinto the specification, to the same extent as if each individualpublication, patent or patent application was specifically andindividually indicated to be incorporated herein by reference. Inaddition, citation or identification of any reference in thisapplication shall not be construed as an admission that such referenceis available as prior art to the present invention. To the extent thatsection headings are used, they should not be construed as necessarilylimiting.

What is claimed is:
 1. An actuating mechanism comprising: a first gearoperably coupled to a threaded screw, said first gear configured torotate said screw around its screw axis; first and second rider elementscoupled to threading of said threaded screw, wherein said first riderelement is attached to a first elongated element and said second riderelement is attached to a second elongated element; a shaft having a longaxis, said screw axis of said screw and said long axis of said shaftbeing colinear with each other; a second gear configured to rotate saidshaft around said long axis of said shaft; and a housing in which thethreaded screw is received, the housing being disposed around said longaxis of said shaft, the housing having therein designated elongatedgrooves within which each of the first and second elements arepositioned, said elongated grooves being configured such that actuationof the second gear does not twist the elongated elements about the longaxis of said shaft; wherein rotation of said threaded screw moves saidrider elements in opposing directions along said long axis of saidshaft, tensioning said first elongated element and releasing tension ofsaid second elongated element or vice versa.
 2. The mechanism accordingto claim 1, wherein rotational movement of said rider elements aroundthe screw is limited by one or more protrusions configured on aninternal face of the housing.
 3. The mechanism according to claim 2,wherein (i) each of said first and second elongated elements isrespectively and proximally attached at to said respective riderelement, and (ii) each of said elongated elements is respectively anddistally attached to said shaft at a location distal to a flexible jointof said shaft.
 4. The mechanism of claim 3 wherein said second gear islocated distal to said first gear.
 5. The mechanism of claim 4 whereinboth of said first and second riders are located distal to the firstgear and proximal to the second gear.
 6. The mechanism according toclaim 1, wherein (i) each of said first and second elongated elements isrespectively and proximally attached to its respective rider element,and (ii) each of said elongated elements is respectively and distallyattached to said shaft at a location distal to a flexible joint of saidshaft.
 7. The mechanism of claim 6 wherein said second gear is locateddistal to said first gear.
 8. The mechanism of claim 7 wherein both ofsaid first and second riders are located distal to the first gear andproximal to the second gear.
 9. The mechanism of claim 1 wherein saidfirst and second riders are both disposed in a location, along the shaftaxis, that is in between the first and second gears.